Nevin ORUÇ, Ahmet AYDIN, Fatih TEKİN, Adem GÜLER, Sinan ERSİN, Müge TUNÇYÜREK, Tankut İLTER

Üst gastrointestinal sistem stromal tümörlerinin endosonografik ve histopatolojik özelliklerinin karşılaştırılması: Tek merkez deneyimi

Amaç: Gastrointestinal stromal tümörler daha çok orta yaşlarda ortaya çıkan mezenkimal tümörlerdir. Endoskopik inceleme tanı için yetersizdir. Endosonografi gastrointestinal stromal tümörlerin incelenmesinde en sık kullanılan görüntüleme yöntemidir. Histopatolojik olarak mitotik aktivitesi yüksek olan büyük lezyonlar, malignite riski yüksek gastrointestinal stromal tümör olarak tanımlanmaktadır. Bu çalışmada gastrointestinal stromal tümörlerin endosonografi bulguları ile histopatolojik özellikleri arasındaki bağlantıların araştırılması amaçlanmıştır. Gereç ve Yöntem: Çalışmaya gastrointestinal stromal tümör şüphesi ile endosonografi yapılan ve opere edilerek histopatolojik olarak tanısı doğrulanan 25 olgu (13 E, 12 K, yaş ortalaması 52.1±16.3) dahil edilmiştir. Bulgular: Olguların tümünde tümörler midede olup, 5'i kardiafundus, 17'si korpus ve 3'ü antrum lokalizasyonludur. On (%40) olguda, tümörün lüminal yüzeyinde ülserasyon varlığı izlenmiştir. Endosonografik olarak ölçülen tümör çapı ortalaması 51.59±20.37 mm olup histopatolojik olarak ölçülen tümör çapı (54.30±24.86 mm) ile oldukça koreledir (r: 0.817, p

Anahtar Kelimeler:

Stromal tümör, endosonografi, malignite, histopatoloji

Comparison of endosonographic and histopathological features of upper GISTs: A single center experience

Background and Aims: Gastrointestinal stromal tumors are mesenchymal tumors mostly prevalent at middle ages. Since endoscopy is insufficient for evaluation of gastrointestinal stromal tumors, endoscopic ultrasound is preferred and mostly used imaging technique. Gastrointestinal stromal tumor lesions with high mitotic activity and large tumor size are usually considered to have a malign potential. We aimed to investigate the correlation between the endoscopic ultrasound findings and histopathologic characteristics of gastrointestinal stromal tumors. Materials and methods: Twenty five patients who underwent endoscopic ultrasound fort he suspicion of gastrointestinal stromal tumor and have the definitive diagnosis of gastrointestinal stromal tumor histopathologically were included to the study (13M, 12F, mean age 52.1±16.3). Results: All gastrointestinal stromal tumors were located in the stomach; five of them in the fundus, 17 in the corpus and 3 in the antrum. There were ulcerations on 10 (%40) gastrointestinal stromal tumor lesions. Mean diameter of the gastrointestinal stromal tumors measured during endoscopic ultrasound evaluation (51.59±20.37mm) was highly correlated with the real tumor size (54.30±24.86 mm, r: 0.817, p

Keywords:

Stromal tumour, endoscopic ultrasound, malignancy, histopathology,

PDF

___

Goettsch WG, Bos SD, Breekveldt-Postma N, et al. Incidence of gastro- intestinal stromal tumours is underestimated: results of a nation-wide study. Eur J Cancer 2005;41:2868-72.
Tryggvason G, Gislason HG, Magnusson MK, Jonasson JG. Gastrointes- tinal stromal tumors in Iceland, 1990-2003: The Icelandic GIST study, a population-based incidence and pathologic risk stratification study. Int J Cancer 2005;117:289-93.
Miettinen M, Majidi M, Lasota J. Pathology and diagnostic criteria of gastro- intestinal stromal tumors (GISTs): A review. Eur J Cancer 2002;38:39-51.
Pidhorecky I, Cheney RT, Kraybill WG, Gibbs JF. Gastrointestinal stro- mal tumors: current diagnosis, biologic behavior, and management. Ann Surg Oncol 2000;7:705-12.
Scarpa M, Bertin M, Ruffolo C, et al. A systematic review on the clinical diagnosis of gastrointestinal stromal tumors. Surg Oncol 2008;98384-92.
Belloni M, De Fiori E, Mazzarol G, et al. Endoscopic ultrasound and computed tomography in gastric stromal tumours. Radiol Med 2002;103:65-73.
Okai T, Minamoto T, Ohtsubo K, et al. Endosonographic evaluation of c-kit-positive gastrointestinal stromal tumor. Abdom Imag 2003;28:301- 7.
Shah P, Gao F, Edmundowicz SA, et al. Predicting malignant potential of gastrointestinal stromal tumors using endoscopic ultrasound. Dig Dis Sci 2008;29.e-pub.
Chatzipantelis P, Salla C, Karoumpalis I, et al. Endoscopic ultrasound- guided fine needle aspiration biopsy in the diagnosis of gastrointestinal stromal tumors of the stomach. A study of 17 cases. J Gastrointestin Li- ver Dis 2008;17:15-20.
DeMatteo RP, Lewis JJ, Leung D, et al. Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg 2000;231:51-8.
Franquemont DW. Differentiation and risk assessment of gastrointesti- nal stromal tumors. Am J Clin Pathol 1995;103:41-7.
Emory TS, Sobin LH, Lukes L, et al. Prognosis of gastrointestinal smo- oth-muscle (stromal) tumors: dependence on anatomic site. Am J Surg Pathol 1999;23:82-7.
Yang HK, Park Do J, Lee HJ, et al. Clinicopathologic characteristics of gastrointestinal stromal tumor of the stomach. Hepatogastroenterology 2008;55:1925-30.
Joensuu H. Risk stratification of patients diagnosed with gastrointestinal stromal tumor. Hum Pathol 2008;39:1411-9.
Lee YT. Leiomyosarcoma of the gastrointestinal tract: General pattern of metastasis and recurrence. Cancer Treat Rev 1983;10:91-101.
Morrissey K, Cho ES, Gray GF Jr, Thorbjarnarson B. Muscular tumors of the stomach: Clinical and pathological cases. Ann Surg 1973;178:148- 55.
Steigen SE, Eide TJ. Gastrointestinal stromal tumors (GISTs): a review. APMIS 2009;117:73-86.
Miettinen M, Sobin LH, Sarlomo-Rikala M. Immunohistochemical spec- trum of GISTs at different sites and their differential diagnosis with a re- ference to CD117 (KIT). Mod Pathol 2000;13:1134-42.
Yamada Y, Kida M, Sakaguchi T, et al. A study on myogenic tumors of the upper gastrointestinal tract by endoscopic ultrasonography. Dig En- dosc 1992;4:396-408.
Chak A, Canto MI, Rosch T, et al. Endosonographic differentiation of be- nign and malignant stromal cell tumors. Gastrointest Endosc 1997; 45:468-73.
Palazzo L, Land B, Cellier C, et al. Endosonographic features predictive of benign and malignant gastrointestinal stromal tumours. Gut 2000;46:88-92.
Fletcher DM, Berman JJ, Corless C, et al. Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol 2002;33:459-65.